Variation among Primary Care Physicians in the Use of Imaging for Older Patients with Acute Low Back Pain

Alai Tan, Jie Zhou, Yong Fang Kuo, James Goodwin

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

BACKGROUND: Diagnostic imaging is not recommended in the evaluation and management of non-specific acute low back pain. OBJECTIVE: To estimate the variation among primary care providers (PCPs) in the use of diagnostic imaging for older patients with non-specific acute low back pain. DESIGN AND PARTICIPANTS: Retrospective cohort study using 100 % Texas Medicare claims data. We identified 145,320 patients aged 66 years and older with non-specific acute low back pain during the period January 1, 2007, through November 30, 2011, cared for by 3297 PCPs. MAIN MEASURES: We tracked whether each patient received lumbar imaging (radiography, computed tomography [CT], or magnetic resonance imaging [MRI]) within 4 weeks of the initial visit. Multilevel logistic regression models were used to estimate physician-level variation in imaging use. KEY RESULTS: Among patients, 27.2 % received radiography and 11.1 % received CT or MRI within 4 weeks of the initial visit for low back pain. PCPs varied substantially in the use of imaging. The average rate of radiography within 4 weeks was 53.9 % for PCPs in the highest decile, compared to 6.1 % for PCPs in the lowest decile. The average rates of CT/MRI within 4 weeks were 18.5 % vs. 3.2 % for PCPs in the highest and lowest deciles, respectively. The specific physician seen by a patient accounted for 25 % of the variability in whether imaging was performed, while only 0.44 % of the variance was due to measured patient characteristics and 1.4 % to known physician characteristics. Use of imaging by individual physicians was stable over time. CONCLUSIONS: PCPs vary substantially in the use of imaging for non-specific acute low back pain. Provider-level measures can be employed to provide feedback to physicians in an effort to modify imaging use.

Original languageEnglish (US)
Pages (from-to)156-163
Number of pages8
JournalJournal of General Internal Medicine
Volume31
Issue number2
DOIs
StatePublished - Feb 1 2016

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Primary Care Physicians
Low Back Pain
Primary Health Care
Physicians
Radiography
Tomography
Magnetic Resonance Imaging
Diagnostic Imaging
Logistic Models
Medicare
Cohort Studies
Retrospective Studies

Keywords

  • back pain
  • care management
  • practice variation
  • primary care
  • quality assessment

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Variation among Primary Care Physicians in the Use of Imaging for Older Patients with Acute Low Back Pain. / Tan, Alai; Zhou, Jie; Kuo, Yong Fang; Goodwin, James.

In: Journal of General Internal Medicine, Vol. 31, No. 2, 01.02.2016, p. 156-163.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Diagnostic imaging is not recommended in the evaluation and management of non-specific acute low back pain. OBJECTIVE: To estimate the variation among primary care providers (PCPs) in the use of diagnostic imaging for older patients with non-specific acute low back pain. DESIGN AND PARTICIPANTS: Retrospective cohort study using 100 {\%} Texas Medicare claims data. We identified 145,320 patients aged 66 years and older with non-specific acute low back pain during the period January 1, 2007, through November 30, 2011, cared for by 3297 PCPs. MAIN MEASURES: We tracked whether each patient received lumbar imaging (radiography, computed tomography [CT], or magnetic resonance imaging [MRI]) within 4 weeks of the initial visit. Multilevel logistic regression models were used to estimate physician-level variation in imaging use. KEY RESULTS: Among patients, 27.2 {\%} received radiography and 11.1 {\%} received CT or MRI within 4 weeks of the initial visit for low back pain. PCPs varied substantially in the use of imaging. The average rate of radiography within 4 weeks was 53.9 {\%} for PCPs in the highest decile, compared to 6.1 {\%} for PCPs in the lowest decile. The average rates of CT/MRI within 4 weeks were 18.5 {\%} vs. 3.2 {\%} for PCPs in the highest and lowest deciles, respectively. The specific physician seen by a patient accounted for 25 {\%} of the variability in whether imaging was performed, while only 0.44 {\%} of the variance was due to measured patient characteristics and 1.4 {\%} to known physician characteristics. Use of imaging by individual physicians was stable over time. CONCLUSIONS: PCPs vary substantially in the use of imaging for non-specific acute low back pain. Provider-level measures can be employed to provide feedback to physicians in an effort to modify imaging use.",
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